Preventing and Treating Sports Injuries of the Foot and Ankle in Youth Athletes

All parents know that children and sports go together and how important sports can be to kids health and happiness. Almost as soon as they start to walk, they’re racing around the house, kicking balls and swinging sticks at anything that can’t move out of the way.

Children’s team sports used to be primarily baseball, basketball, or football. That’s changed. Soccer is now the most popular youth sport and lacrosse is coming on strong.

Kids now start training at younger ages. This is particularly true in individual sports such as dance, track, swimming, cheer, skating and gymnastics grows younger every year.

Overuse Injuries in Children

There is an epidemic of overuse sports injuries in active kids. We see this every day in our Seattle foot and ankle clinic. Many, if not most of these injuries are due to a move in recent years toward specialization. Instead of playing one sport, kids have more tendency to specialize in a single sport. In general, kids are getting injured because:

  • They spend too many hours playing sports before their bodies have developed sufficiently to handle the stress
  • They are specializing too much in one sport.

If your child has a foot or ankle sports injury contact us for an appointment in our Seattle clinic. 

Avoid Playing More Hours Than the Child’s Age

Kids who specialize in one sport and train extensively in it have a 70% higher change of overuse injuries such as stress fracture according to a large scale 2018 study.1  Another large scale study from 2017 found essentially the same results with those young athletes who had moderate specialization having a 50% greater chance of injury and those who had high specialization having an 85% increased chance of injury.

The greatest chance of injury occurred in kids who trained in a single sport for more hours per week than their age. So a 10 year old who plays soccer 11 hours per week has a much greater chance of experiencing overuse injuries than those who were just as active but not spending as much time on one sport.

Some other findings from this study included:

  • Injury rates in young athletes were doubled if they spent more than twice as much time playing organized sports as they spent in unorganized free play — for example, playing 11 hours of organized soccer each week, and only 5 hours of free play such as pick-up games.
  • Total time spend in sports activities should probably be less than 18 hours per week to avoid injury. Those kids who experienced serious injuries spent an average of 21 hours per week in total physical activity (organized sports, gym and unorganized free play). An average of 13 hours was spent in organized sporting activities. Those kids who did not get injured, by comparison, participated in less activity – 17.6 hours per week in total physical activity, including only 9.4 hours in organized sports.
  • Injured athletes were more much more likely to specialize in a single sport.

Tips to Prevent Injuries in Young Athletes

  • The maximum number of hours per week playing sports should be equal to the child’s age.  Younger kids are simply developmentally immature and are not able to handle physical stress as well as older kids.
  • Time playing organized sports should never exceed twice the time spent in the gym and unorganized play.
  • Do not specialize in one sport before late adolescence.
  • Sports should not be played competitively year round. At least one – three months should be taken off each year.  This does not need to be done consecutively.
  • Take at least one day off per week from training in sports.

Parents should encourage their children to participate in sports, but never forget that competition should be fun. Too much emphasis on winning and being the best can lead to injury and alienate a child from athletic competition.

Sports are Important – But Sports Specialization Significantly Increases Injury Risk

Children active in sports programs will improve their cardiovascular health, their strength and coordination. Being active in sports early leads to increased bone strength that can last a lifetime  And of course there are social and emotional benefits also. Participation in sports develops a sense of self discipline, teamwork, and recognition of the importance of a healthy body — good habits that last a lifetime.

But to avoid injury kids should avoid specializing in sports before their late teens. Sports specialization itself increases risk of lower extremity injury. This is independent of simply spending more time playing sports.2

If you are worried that not specializing will hurt your chances at sports success at higher levels, don’t be. A recent study showed that NBA players who participated in multiple sports as kids had fewer injuries and longer careers.3

What Parents Need to Know About Growing Bones and Ligaments

Children’s bones are immature and do not handle stress the same as an adults.  The “growth plates” in children’s bones are not mature until age 15-17 in boys and 13-15 in girls. When exposed to excessive or repetitive force, these plates are much more prone to becoming injured than the tendons and ligaments that support the joints. In adults the opposite is true. Bones are stronger and ligaments and tendons tend to get injured before the bone.

Repetitive motion (doing the same thing over and over) can lead to swelling and damage of the growth plates. This is a primary reason that it is so important to avoid doing the same sport over and over.  For your kid’s sake, have them play a variety of sports throughout the year.

In our Seattle foot and ankle clinic we can offer a thorough examination of the entire lower extremity, and identify a foot imbalance, leg length difference, weakness, or biomechanical abnormality that, if treated, can prevent injuries.

Training Young Athletes to Prevent Foot and Ankle Injuries

Kids all mature at different rates. Also, each child has a different degree of athletic ability. Regardless of natural ability, proper training can improve improve coordination, and therefore performance.

At young ages training should focus on proper technique and basic movement skills in all sports. This is particularly true in kids younder than 10 years. Its important, so we’ll say it again, children who spend most of their time on a single sport at too young an age are much more likely to develop injuries of the foot and ankle. Sports specialization in sports should not be started until the late teens.

Common Sports Injuries in Kids

Ankle Sprains

More common in older kids who have mature growth plates, stretched or torn ligaments in the ankle, known as sprains, are more common than fractures. Treatment should begin immediately.  Proper early treatment can speed healing and prevent a lifetiem of unstable ankles.  Learn more about ankle sprains here.


Fractures from overuse in young athletes are common injuries.  Growth plates are especially prone to being injured but fractures of the bone also occur. If a fracture is not severe, rest and immobilization in a walking boot may be sufficient. More severe fractures may require non-weighbearing, casting or surgery.  Anytime pain or swelling persists contact us or your pediatrician.

Growth Plate Inflammation

There are several common growth plate injuries seen in child atheletes.  The most common is at the heel and is know as Sever’s disease or calcaneal apophysitis.  Learn more about calcaneal apophysitis here.

Other common growth plate injuries can occur at the base of the 5th metatarsal bone, the navicular bone and the 2nd metatarsal head. Sometimes due to an “extra bone” in the foot, you can learn about these growth plate injuries here.

Shin splints and stress fractures

Learn more about shin splints here.

Seattle Pediatric Foot and Ankle Sports Injury Experts

Don’t let your child live with foot, ankle or leg pain. Most problems can be treated with conservative and pain-free treatment. Contact us today for an evaluation in our Seattle office.


  1. To be published. Presented by Dr. Neeru Jayanthi during an oral podium research session April 19 2018 at the American Medical Society for Sports Medicine (AMSSM) meeting in San Diego.
  2. Timothy A. McGuine, PhD, ATC.  A Prospective Study on the Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes. The American Journal of Sports Medicine; July 23, 2017
  3. Rugg, C. et. al. NBA athletes who played in multiple high school sports had fewer injuries, longer careers.  Am J Sports Med. 2017

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